Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
Shelitha Banks
Concord ,NC
Work Preference
Summary
Claims Manager managing internal functions of teams, promoting high levels of quality production and overseeing specialized operational functions. Constructed concurrent objectives to promote efficiency and influence positive outcomes. Dedicated to team success while solving problems with minimal oversight.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Risk and Claims Manager
Krispy Kreme
Charlotte, NC
05.2023 - Current
- Analyzes and processes complex or technically difficult workers compensation, auto and general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
- Sending out the legal notices that are required by the states to inform the injured worker of their rights, and any benefits that they may or may not be entitled to.
- Working with each employer and each injured employee to get the injured worker well and back to work, even if it's in a light-duty or a modified position.
- Communicates effectively, both in writing and orally, with customers, including, but not limited to, claimants, witnesses, employees, attorneys, medical professionals, governmental entities, and contractors.
- Determines the value and extent of related damages and/or workers compensation injuries by verifying support documentation and reviewing medical bills.
- Negotiates claim settlements within designated authority.
- Prepares necessary state filings within statutory limits.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
- Provide exceptional customer service by establishing and maintaining productive business relationships with employees
- Implemented risk mitigation measures such as quality assurance reviews of high-risk cases.
Compliance Analyst
UBS Financial Services/Contract
Charlotte, NC
10.2022 - 05.2023
- Act as an assessor in accordance with the Firm's Violations Framework Policy
- Establish and review facts and circumstances of potential policy and/or conduct violations identified by various groups within the firm
- Determine level of severity of incident based on fact check and documentation
- Enter violation and all relevant details, taxonomies, and policy breaches in Firm's Case Management Tool
- Ensure all appropriate documentation is retained in accordance with firm policy
- Work in conjunction with WM Divisional team and Field management to Issue policy reminders and conduct violations as necessary
Financial Crimes Analyst
Varo Bank
NC
11.2021 - 08.2022
- Following established guidelines and procedures, perform routine compliance tasks and handle routine compliance issues, typically concerning documentation, reporting, etc.
- Assist in monitoring regulatory issues.
- Review and research suspect items and/or transactions and report suspicious activity, as required
- Taking what is recommended from the alert researches and analyzes deposits, withdrawals, and transfers to identify possible cases of money laundering or terrorist financing
- Research and analyze trading transactions to identify possible cases of market abuse
- Effectively investigate, document, and identify suspicious activity and use seasoned judgment for activity to determine if a SAR needs to be filed
- Preform extensive background investigations using public and private databases in accordance with AML and other regulatory standards to help prevent operational and reputational risk
- Communicate activity and trends that could be related to potential money laundering or terrorist financing to with the AML Compliance Manager
- Analyzes issues and use judgment to make decisions.
- Escalates non-standard problems or issues as needed
- Stay apprised of regulatory matters and developments through regular review of appropriate compliance publications and websites and by participating in relevant compliance conferences and other training events.
- Worked under Banking Regulations Reg E and/or Reg Z, as well as UDAAP
- Reviewing risk related data inputs, documenting results, and making recommendations of potential impacts to risk programs
- Developing a process to report on risk assessment results that will ensure risk related data inputs are reported on and considered in risk programs
- Identifying, assessing, and communicating emerging issues, themes and trends based on various information gathering methodologies
- Participate in key projects impacting KYC
- Follow established written procedures and guidelines, provide technical and analytical support in a global markets operations support function for one or more operations product areas
- Use established techniques to analyze and resolve complex operations support problems/initiatives requiring exception handling and/or coordination of multiple operational and/or product/services specialists to resolve
- Facilitated getting work done without coercion, assigning or dictating work.
- Assisted with internal and external communication, improving transparency, and radiating information
- Assisted in managing projects and/or introduction of new initiatives, systems, products and services and processes coordination across multiple operations functions
- Removed impediments and guided the team to remove impediments by finding the right stakeholders to remove the impediment and driving solutions through to completion
- Established and improved a suitable calendar of ceremonies to ensure clear lines of communication and collaboration across multiple times and time zones
Claims Examiner II
Lincoln Financial Group
Charlotte, NC
03.2021 - 05.2022
- Applies knowledge of disability products, policies and contracts.
- Interprets and applies contract/policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements.
- Utilizes reference materials and tools regarding medical, vocational and disability issues to identify and evaluate claim information in a fair and objective manner.
- Efficient use of applicable disability claims system(s).
- Applies routine medical and technical claims skills, practices, and procedures.
- Utilizes most efficient means to obtain claim information
- Fully investigates all relevant claim issues.
- Provides payment or denials promptly and in full compliance with department procedures and regulations.
- Determine and implement appropriate return to work strategy for assigned cases.
- Applies contract specifics regarding eligibility and pre-existing formulas in reference to specific claim.
- Communicates with claimants, policyholders, and physicians to resolve investigations concerns.
- Comfortably makes balanced decisions in situations where there are potential adverse consequences.
- Utilizes appropriate intervention for the characteristics of each claim.
- Manages assigned case load of 100-110 complex and some simple cases independently.
- Collaborates with team members and management in identifying and implementing improvement opportunities.
- Communicates with claimants, policyholders, and physicians to resolve investigations concerns.
- Comfortably makes balanced decisions in situations where there are potential adverse consequences.
- Manages appropriate volumes, consistently meeting turnaround times, high activity levels, and quality focus on timely claim activities.
- Consistently remain within workflow guidelines on diaries and casework & adjust desk management if needed.
- Provides clear, concise and accurate information to claimants as well as the claims administrative system.
- Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
- Establishes, communicates, and manages claimant and policyholder expectations.
- Documents claim file actions and telephone conversations appropriately
Financial Crimes Specialist III
Wells Fargo
12.2017 - 02.2021
- Working all complexities and risk levels: Low, Medium and High priority cases
- Conducting research in internal and external systems to review CIP/CDD elements
- Analyzing submitted documentation to determine if it meets established guidelines
- Quality Assurance (QA) Review all work for complete Accuracy
- Coaching and arbitrating on best practice, without being overbearing as maturity develops
- Ensures compliance with company and regulatory policies and procedures
- Knowledge and understanding of regulatory compliance requirements surrounding
- USA PATRIOT Act and Anti Money Laundering (AML) requirements
- Utilized Banking Regulations and Bank Card Association Rules to include Reg E and/or Reg Z, as well as UDAAP
- Trains team on Address Standardization, E111, Assumption Loans
- Completing very detailed work with a high degree of accuracy
- Participates in creation and adherence to business case
- Supports senior Program and /or Project Managers in scheduling, prioritization and 2 sequencing for work efforts.
- Facilitated getting work done without coercion, assigning or dictating work.
- Assisted with internal and external communication, improving transparency, and radiating information
- Assisted in managing projects and/or introduction of new initiatives, systems, products and services and processes coordination across multiple operations functions
Financial Crimes Specialist II-Claims
Wells Fargo
01.2015 - 01.2017
- Reviews, verifies and/or identifies customer transactions to detect/prevent financial crimes activities, policy violations and suspicious situations in order to mitigate and/or recover losses
- Monitors moderate to complex account activity which requires research that may involve multiple transaction channels
- Uses a variety of sources for information, including online systems and tools/models
- May perform general account handling functions such as close account determination, holds, restraints, etc
- Document research findings and actions on cases for possible referrals for Suspicious
- Activity, Identity Theft Operations (ITO) and Suspected Financial Abuse
- Utilized Banking Regulations and Bank Card Association Rules to include Reg E and/or Reg Z, as well as UDAAP and all financial regulations.
- May contact customers and/or vendors to validate transactions
- May maintain files, records, databases and prepare standard/routine management reports
- Prepares required documentation including Suspicious Activity Reports
- Identified control failures in bank processes, procedures, and customer or team member decisions and then categorize losses and assign loss accountability
- Reviews more complex/unique situations with senior department staff.
Financial Crimes Specialist II
Remedy Temp Staffing (Contract with Wells Fargo)
Charlotte, NC
07.2014 - 01.2015
- Reviews, verifies and/or identifies customer transactions to detect/prevent financial crimes activities, policy violations and suspicious situations in order to mitigate and/or recover losses
- Monitors moderate to complex account activity which requires research that may involve multiple transaction channels
- Uses a variety of sources for information, including online systems and tools/models
- May perform general account handling functions such as close account determination, holds, restraints, etc
- Document research findings and actions on cases for possible referrals for Suspicious
- Activity, Identity Theft Operations (ITO) and Suspected Financial Abuse May contact customers and/or vendors to validate transactions
- May maintain files, records, databases and prepare standard/routine management reports
- Prepares required documentation including Suspicious Activity Reports May identify control failures in bank processes, procedures, and customer or team member decisions and then categorize losses and assign loss accountability
- Reviews more complex/unique situations with senior department staff.
Education
Bachelor of Science - Applied Studies, Criminal Law
University of Iowa
Iowa City, IACertified Scrum Master -
Scrum Alliance
Charlotte, NC10.2022
Lean Six Sigma Green Belt -
Central Piedmont Community College
Charlotte, NC12.2020
Associate of Applied Science - Criminal Justice
Iowa Central Community College
Fort Dodge, IA10.2018
Skills
Attention to Detail
Professionalism
Team Leadership
Problem Solving
Accountability
Ability to Motivate
Prioritizing Skills
Customer Service Satisfaction
Banking Knowledge
Business Systems
Risk Assessment
Resource Management
Communication
Time Management
TECHNICAL SKILLS
Excel
IRS E-Services
EFW
DIPR
Microsoft Office
Lexis Nexis
Hogan
CIV
Softphone
Universal Workstation
Pivot Tables
VLOOKUP’s
PowerPoint
Troubleshooting
Fraud detection
Banking ethics knowledge
Crime trend analysis
Identity theft training
Evidence collection
Researching skills
Verafin
Fiserv
Visio
SAR Filing
FinTech
JIRA
Oracle e-Business Suite
Certification
- Texas Adjuster-All Lines License #3252130
Education and Training
true,false,other
Timeline
Risk and Claims Manager
Krispy Kreme
05.2023 - Current
Compliance Analyst
UBS Financial Services/Contract
10.2022 - 05.2023
Financial Crimes Analyst
Varo Bank
11.2021 - 08.2022
Claims Examiner II
Lincoln Financial Group
03.2021 - 05.2022
Financial Crimes Specialist III
Wells Fargo
12.2017 - 02.2021
Financial Crimes Specialist II-Claims
Wells Fargo
01.2015 - 01.2017
Financial Crimes Specialist II
Remedy Temp Staffing (Contract with Wells Fargo)
07.2014 - 01.2015
Bachelor of Science - Applied Studies, Criminal Law
University of Iowa
Certified Scrum Master -
Scrum Alliance
Lean Six Sigma Green Belt -
Central Piedmont Community College
Associate of Applied Science - Criminal Justice
Iowa Central Community College